Medical illustration of Monkeypox virus - 3D illustration

Blog: ‘We still need to be alert to MPox’

A year on from the MPox (formerly named MonkeyPox) outbreak that affected the UK and many other countries across the world, Advanced Public Health Practitioner & Sexual & Reproductive Health lead James Woolgar, reflects on what we learnt, and explains why we should remain vigilant.

“We have made excellent progress tackling MPox in the UK since the outbreak was first identified in May 2022. It is an infection that causes a skin rash or lesions which can be extremely painful and are often accompanied by fever and headaches.

Until this outbreak, MPox was considered rare, and a disease that largely affected African countries. However, the recent case profile has changed all that. MPox also appears to havechanged in terms of the main way it is transmitted. Previously it was mostly via social contact, but this time we have seen it largely spread via specific sexual networks and it has particularly affected certain groups (eg. gay, bisexual and other men who have sex with men). This has led to our sexual health services leading large parts of the response around testing, notification of results and vaccination.

The number of new cases per day peaked at 350 per week in July 2022, but then reduced significantly to 13 per week by October, with the majority of cases still being in gay, bisexual and other men who have sex with men. To put this into perspective, we had only seen 7 cases of MPox in the UK between 2018 and 2021, prior to this outbreak.

We still continue to see new cases in the UK and indeed cases across the world (particularly Europe, North America and South America), however these are very small in number. In fact, we had only seen 5 new cases in the UK in 2023, until recent unconfirmed data suggests MPox may be making a comeback.

In Liverpool we kept case numbers to a minimum as a result of some excellent partnership working, including AxessSexual Health, Liverpool PaSH, Sahir House and other leads within LUHFT infectious diseases team. Data shows that we saw less than 20 cases in the city. We’re very proud of this work as it placed us amongst the best performing core cities in terms of total numbers and meant we protected our local population from harm.

A combination of factors contributed to the reduction seen in case numbers by the end of 2022. Firstly, there were detailed communication strategies that raised awareness and that led to more people seeking clinical advice and testing and helped change people’s behaviour. We then also had the vaccination strategy. Key risk groups were offered the smallpox vaccine (imnavex) in two separate doses to give vital protection and prevent people passing the infection to others.

In Liverpool, we scaled up a local working group between public health leads and service providers, including those partners listed earlier. This helped us expertly organise communications strategies and approaches via outreach and to organise a fast response to vaccination. LUHFT were designated an early pilot hubs to drive vaccination uptake and managed to reach people very soon after UKHSA gave us vaccine stock.

Public Health leads are also driving a key research piece (withthe Liverpool School of Tropical Medicine) to understand effective communication strategies around this outbreak and to make recommendations around improving future approaches related to response.

This work will include interviews and engagement work with experts and also groups of people most affected to gain knowledge and insight into what strategies might work and how we remove barriers to accessing vaccination. We will publish this and feed it into national UKHSA leads at high level.

Where are we now?

We learned a lot during this outbreak. Some groups were disproportionately affected, and so understanding early who was at risk was key to things like communications and messaging. Crucially our work locally was centred aroundsending robust communications and advice to all of our communities, utilising World Health Organisation (WHO) Guidance for large events and social gatherings. This helped us to combat any early stigma that we saw nationally around MPox being an issue only for certain groups.

At the height of the outbreak, vaccination supplies were not always consistent either. This did provide challenges in relation to the call for 1st and 2nd dose vaccination for key eligible groups. Local providers managed to get hold of enough vaccine locally, and, supported by our outreach teams and a solid communications plan, eligible groups were made aware and called forward.

The outbreak was brought under control and it was announced earlier this year that (with so few cases and no evidence of ongoing transmission) the outbreak was officially over. However, not everyone returned for their second dose, which makes the vaccine less effective. This is rather worrying and means we must not be complacent. People who are eligible but have not yet received 2 doses of vaccine can still contact sexual health services to receive these up to the of end July 2023.

Very recent reports suggest a resurgence of infection, with UKHSA releasing a statement urging people to remain vigilant to MPox ahead of the summer months, as we have seen a case increase in London over the past four weeks.

Through the first few months of this year we had only seen 5MPox cases in England and it was felt the vaccination strategy had all but ended it. However, recent data shows that we now have another cluster of cases in London (10), and some cases across Europe. This without doubt means we must remainvigilant, and work with key national leads in UKHSA to prevent further spread.

It is still important to remain aware of the symptoms, and to speak to local sexual health services if you suspect any symptoms are MPox. MPox is transmitted via close social contact, and that has very much included via sexual contact during this situation”.

Axess Sexual Health for any support or advice on vaccination/symptoms –

Latest UKHSA Press Release (4pm, 25th May 2023):

Latest mpox cases a reminder that the infection has not gone away – GOV.UK (

There are a host of supporting blogs and materials offering further useful information:

UKHSA pages –

UKHSA – Background information/symptoms/vaccination recommendations

THT pages –

Liverpool Waterfront